HEMODYNAMIC INSTABILITY AFTER CAROTID ENDARTERECTOMY - RISK-FACTORS AND ASSOCIATIONS WITH OPERATIVE COMPLICATIONS

OBJECTIVE: To examine the incidences of hypertension, hypotension, and bradycardia after carotid endarterectomy (CEA) and to identify any he modynamic variables predictive of postoperative stroke, death, or card iac complications. METHODS: Retrospective population-based cohort stud y of 291 consecutive patients undergoing CEA using hospital chart revi ew. Hemodynamic data collected from time of arrival in the recovery ro om until the end of the Ist postoperative day. Primary and secondary o utcome events were stroke or death within 30 days of surgery and any p ostoperative cardiac complication (angina, congestive heart failure, d ysrhythmia, or myocardial infarction), respectively. RESULTS: The inci dences of postoperative hypertension (systolic blood pressure >220 mm Hg), hypotension (systolic blood pressure <90 mm Hg), and bradycardia (pulse <60 beats/min) were 9% (26 of 290 cases), 12% (36 of 290 cases) , and 55% (159 of 290 cases), respectively. The stroke or death rate w as 5.2% (15 of 291 cases). Postoperative hypertension was associated s ignificantly with stroke or death (P = 0.04) and by a statistical tren d with cardiac complications (P = 0.07). Independent preoperative risk factors for postoperative hypertension by multivariate analysis inclu ded angiographic intracranial carotid stenosis greater than 50%, cardi ac dysrhythmia, preoperative systolic blood pressure greater than 160 mm Hg, neurological instability, and renal insufficiency. Postoperativ e hypotension and bradycardia did not correlate with primary or second ary outcomes. CONCLUSION: Hemodynamic instability was commonly observe d after CEA, but only postoperative hypertension was associated with s troke or death and, possibly, with cardiac complications. Patients und ergoing CEA, especially those at risk for postoperative hypertension, may be monitored best in settings suited to the expeditious management of neurological and cardiovascular emergencies.